结合传统医疗与远程医疗服务以减轻农村地区紧急医疗服务负担：一项回顾性队列研究

Combining Conventional and Telemedicine Medical Services to Reduce the Burden on Emergency Medical Services in Rural Areas: A Retrospective Cohort Study.

作者信息

Inokuchi Ryota, Sakamoto Ayaka, Sun Yu, Iwagami Masao, Tamiya Nanako

机构信息

Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.

Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.

出版信息

Prehosp Emerg Care. 2025 Feb 7:1-6. doi: 10.1080/10903127.2025.2460205.

DOI:10.1080/10903127.2025.2460205

PMID:39889223

Abstract

OBJECTIVES

During the COVID-19 pandemic, the number of ambulance calls increased sharply, and ambulances could not be dispatched due to unavailability, especially in rural areas. This study assessed the integration of traditional emergency care systems in rural areas with online medical services from urban areas.

METHODS

In this retrospective observational cohort study, patients recovering from mild COVID-19 at home who called an ambulance (November 2022 to January 2023) in Asahikawa, Japan were included. When an emergency call was received, the fire department control center initiated an online medical consultation to ascertain the necessity of ambulance transport while conventionally dispatching an ambulance. We compared chief complaints and patient characteristics between those who were transferred to hospitals and those who were not transferred, considering the time from the beginning of the 1-1-9 call to the start of the online service, and the duration of the online consultation for each group. The statistical significance of the differences between groups was analyzed by the Mann-Whitney U-test for continuous variables and the chi-square test or Fisher's exact test for categorical variables with statistical significance set at < 0.05.

RESULTS

Among the 136 patients, 73 (53.7%) were transferred to a hospital ambulance. The median age of the transferred patients was significantly higher, at 83 years (interquartile range (IQR): 57-90), compared with 37 years (IQR: 26-60) for those not transferred ( < 0.001). A significantly higher number of transferred patients had hypoxemia (17, 23.3%; vs. non-transferred, 2, 3.2%; < 0.001). The time from the start to the end of the online consultation was shorter for the transferred patients (13 min (IQR: 8-20) compared to non-transferred patients (15 min (IQR: 13-22); < 0.001). There were no significant differences between groups in terms of sex, medical history, other chief complaints, or the time from the start of the 1-1-9 call to the start of the online service.

CONCLUSIONS

Online medical services have the potential to optimize medical resource allocation and utilization in rural areas.

摘要

目的

在新冠疫情期间，救护车呼叫数量急剧增加，且由于救护车无法使用，尤其是在农村地区，无法进行调度。本研究评估了农村地区传统急救系统与城市地区在线医疗服务的整合情况。

方法

在这项回顾性观察队列研究中，纳入了日本旭川市在家中从轻度新冠中康复且呼叫救护车的患者（2022年11月至2023年1月）。接到紧急呼叫时，消防部门控制中心启动在线医疗咨询，以确定是否有必要用救护车转运，同时按常规调度救护车。我们比较了被转运至医院的患者和未被转运的患者的主要症状和患者特征，考虑了从拨打1-1-9电话开始到在线服务开始的时间，以及每组的在线咨询时长。对于连续变量，采用曼-惠特尼U检验分析组间差异的统计学意义；对于分类变量，采用卡方检验或费舍尔精确检验，设定统计学显著性为<0.05。

结果

在136例患者中，73例（53.7%）被转运至医院的救护车。被转运患者的中位年龄显著更高，为83岁（四分位间距（IQR）：57-90），而未被转运患者为37岁（IQR：26-60）（<0.001）。被转运患者中低氧血症的人数显著更多（17例，23.3%；未被转运患者为2例，3.2%；<0.001）。被转运患者从在线咨询开始到结束的时间更短（13分钟（IQR：8-20），而未被转运患者为15分钟（IQR：13-22）；<0.001）。在性别、病史、其他主要症状或从拨打1-1-9电话开始到在线服务开始的时间方面，两组之间无显著差异。